Public Health: Disease, Epidemic & Pandemic Threat (merged thread)
World warned over killer flu pandemic
By Ben Russell, Political Correspondent
Monday, 21 July 2008
The world is failing to guard against the inevitable spread of a devastating flu pandemic which could kill 50 million people and wreak massive disruption around the globe, the Government has warned.
In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.
http://www.independent.co.uk/life-st...ic-872809.html
Hate to say it, but as soon as...
you use the term "Universal healthcare", you are screwed. That's the standard code phrase (political speak) for 100% government controlled and provided healthcare, and battle's over at that point - you lose.
Is what we have now really that good - well, not really (and that's being polite). Could we have designed such a disorganized out-of-control rolling cluster of a health care delivery system if we had tried to? - probably not - to get this screwed up, we had to let this whole mess improve with age.
But, doesn't matter - "Universal healthcare" is DOA because of everything it brings to the table.
On the associated topic,
Quote:
The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is too late and the infection/spread rates are totally out of control.
That's only partially true, and there's much, much more to it. And "Universal Healthcare" will in no way make it better - probably little, if any effect at all. Here's why (as an example I'm personally aware of).
Most local Health Departments part in the health "food chain" can be broadly summarized as follows (bottom to top):
1. Local Entities/providers:
1.a Local health care providers (individuals/practices)
1.b Hospitals, clinics
2. Local Health Departments:
2.a Environmental Health (Food Safety; Well & Septic, Solid Waste, Radon, etc., etc., etc.)
2.b Clinical Health (provide services to individuals; WIC, etc.)
3. State Public Health
4) Federal Public Health:
3.a CDC
3.b NIH
3.c DHS (don't even get me started on them; with their "grants" to local health departments of such useful items as HAZMAT suits that nobody ever used, radiation detectors, 'lightweight' GPS units which were the weight and size of Chicago street paving bricks, etc.)
3.d Others
Ok, let's start here: Most of the work gets done by the locals. Any hospital doing even a halfway decent job (which honestly, most of them do a decent job at this part) already have in place a rapid response environment (usually digital) for tracking "unusual events" such as infections, unusual situations, etc. The problem in most cases isn't the locals at all.
The problem (at least here in IL) is with our wonderous, quite inept state government. Right around 2001/2002, I believe, the feds set aside $$$$ for each state to create real time digital reporting, run by each state public health agency to quickly identify and report such outbreaks and incidents to the state public health agencies, and consequently to the feds - bypassing the local health departments, because they had been "ineffective" up to this point.
So, our state took the money and ran with it - giving big bucks to a politically well connected firm to create from scratch a new, miracle, magical digital system which would allow the state folks to track everything in every which way known to mankind. And what they did was to spend all the big money (and it was supposedly ended up being in excess of $10 mil, but who really knows) to create a digital version of the paper process that already was in place.
Now, there were at least 2 private companies that already had digital systems that existed, were battle tested by the hospitals which were using them, but no, we got to create our own from scratch. Which we did, right here in IL. And guess what, the local Health Departments are charged with training and getting all the local health providers to use this monstrosity of a system - and guess what, it blows chunks. I mean, it is really terrible to use, nobody who is on the front lines wants to use it, you can easily kill 15+ minutes just putting a single record into this thing, it's a complete and total waste.
And then just to top things off, and let's make things just a little bit worse, then you have to throw in HIPA (Health Insurance Privacy Act) requirements right on top of this thing, so let's just make things a little more complex and even more difficult.
So, here's the hard reality. It's 9:30 AM, and I've got a patient with symptoms that probably should be reported, but we're on the treadmill of seeing patients, and I don't have 5 minutes, much less 15 minutes. It's going to wait, and hopefully staff can get some free time to deal with the reporting system. Course, I'll have to get the 185 page manual out with the step-by-step instructions, and the 3 level logins and passwords required to get in, oh, and btw, what's our state assigned 30 character identifier for our medical practice?
Oh, and btw, the feds are supposedly as happy as clams about IL and their new infectious disease reporting system, even though most everybody who really has to use it thinks it's a mostly worthless piece of crap.
Btw, if you really want to see the true back story, get a copy of the paper reporting forms used before this new system was put in place, and then get a copy of the full user manual for the new system. After you look at the two separate items, it's pretty apparent that the overriding design process was: "Do it the same way it's always been done, only do it a little better".
/End of rant
JUst had to make me start a thinkin on my day off, didn't you :D ....
Originally posted by Selil:
Quote:
Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.
Ok, so let's get started & do some serious "thought processing" here:
Initial Analysis: First off, the above post by Selil should be the starting point. But the following rules need to be attached to it:
01 The entire concept of "Universal Healthcare" does not apply to this process in any way, shape, or form. NONE. This step is a basic requirement, for political purposes. If we don't do this, and stick to it, the entire process is DOA.
02 The information release compliance areas of HIPA (the rules are arcane, and the penalties, even for accidental disclosure are draconian) are currently also applied to public health agencies. These HIPA requirements need to be eliminated for (a) public health reporting purposes, and (b) for private entities making such reports solely to local public health agencies. We need accurate, detailed information fast, and guess what, HIPA requirements as applied out in the real world makes almost all of that process impractical.
So once 01 & 02 are done, now we can get serious about building a Pandemic EW (early warning) system. If you want to do it right the first time, and get it done quickly, here's how.
03 Forget the typical software design, where you get tons of committees together & re-build the "Camel". Takes way too long, and probably everybody here can imagine the results.
04 Solution: Take $500 mil, call up Larry Page and Sergey Brin (Founders of a little bitty corporation known as "Google"), tell them there is a project for the development and implementation of a Pandemic EW System (PEWS???) that is essential to the National Security of the United States of America, and it's Google's responsibility to make it happen. They have 3 years to get it done, and $500 mil. Federal anti-trust regs do not apply to this project.
Give them a copy of this thread, with all the posts, and then get the hell out of their way. Let them have at it.
Ok, so there's my "solution" for building a useful, workable, highly functional Pandemic EW System - ID the best and the brightest, tell 'em what the problem is and set the stage for them to handle it, turn them loose, and get the hell out of the way.
Then there's the entire healthcare issue. Oh yeah, that's a jewel. Next post...
Beating Ebola From The Sea
Beating Ebola From The Sea
Entry Excerpt:
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Read the full post and make any comments at the SWJ Blog.
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Ebola and the African Responsibility
Ebola and the African Responsibility
Entry Excerpt:
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Public Health Threats (Outbreaks)
Separate thread for max visibility, then Dave can reposition as appropriate.
Anyone with half-a-functioning imagination can see where this problem could be exploited by the Bad People for asymmetrical purposes.
Quote:
yesterday afternoon, the CDC also released a report about a Nevada woman who died after an infection resistant to 26 antibiotics, which is to say all available antibiotics in the U.S. The woman, who was in her 70s, had been previously hospitalized in India after fracturing her leg, which led to an infection of the bone. There was nothing to treat her infection—not colistin, not other last-line antibiotics. Scientists later tested the bacteria that killed her, and found it was somewhat susceptible to fosfomycin, but that antibiotic is not approved in the U.S. to treat her type of infection
https://www.theatlantic.com/health/a...50/#pt0-840044
http://i.imgur.com/a8OlulE.jpg
We’re not prepared for future Ebola outbreaks, experts warn
From an unheard of website via Twitter, a report that opens with:
Quote:
Despite recent headlines
declaring the success of an experimental Ebola vaccine, the world is not fully prepared for future epidemics — and not in position to use vaccines to prevent another deadly outbreak,
a report published Tuesday warned.
Link:https://www.statnews.com/2017/01/17/...ccine-warning/
Africa’s missing Ebola outbreaks
Via The Conversation, an academic site, I found this article; which starts with:
Quote:
During the fallout from the 2014 Ebola outbreak in West Africa, which
killed more than 11,000 people, one of the questions asked of the World Health Organisation (WHO) was why it hadn’t reacted more quickly. The four-month delay in pinning down the cause of the disease that erupted in Guinea’s remote Guéckédou province in December 2013 allowed what might have been a localised event in a single village to turn into the biggest infectious disease crisis of recent times....Ebola was not a West African disease. So why would anybody suspect it had broken out there?
Link:https://theconversation.com/africas-...tbreaks-80301?
'Disease X' & the World Health Organization
Might as well just call it 'Captain Tripps'.
Two mainstream media takes -
Unknown 'Disease X' flagged by World Health Organization, could cause 'serious international epidemic'
Quote:
Scientists warn that an unknown "Disease X" poses a major health risk and could cause a "serious international epidemic" in the future.
Disease X was listed by the World Health Organization as one of eight priority diseases. Others on the list include Ebola, Zika and Lassa fever.
http://www.nydailynews.com/news/worl...icle-1.3866762
Quote:
What is Disease X?
Disease X is not a newly identified pathogen but what military planners call a “known unknown”. It’s a disease sparked by a biological mutation, or perhaps an accident or terror attack, that catches the world by surprise and spreads fast.
By including it on the list, the WHO is acknowledging that infectious diseases and the epidemics they spawn are inherently unpredictable. Like the Spanish flu which killed 50m to 100m people between 1918 and 1920, Disease X is the catastrophe nobody saw coming until it was too late.
Quote:
Where might it come from?
One source of Disease X could be the deliberate utilisation of infectious disease as a weapon.
While bio-weapons have been used since the middle ages (the Tartars catapulted the cadavers of plague victims into the besieged seaport of Caffa in 1346, for example), new scientific developments including gene editing and an exponential increase in computing power make it easier than ever to develop lethal biological agents.
The US and USSR explored bio-weapon development during the Cold War and both continue to hold live cultures of deadly pathogens, including the smallpox virus, in secretive and (hopefully) secure labs. More recently, the Iraqi military toyed with botulinum toxins under Saddam Hussein, Al Qaeda operatives experimented with anthrax and, in 2014, a laptop captured from Islamic State (IS) was found to contain instructions on how to weaponise the plague virus.
https://www.telegraph.co.uk/news/0/b...s-awake-night/
From WHO -
World Health Organization 2018 annual review of the Blueprint list of priority diseases
http://www.who.int/blueprint/priority-diseases/en/
A new disease is testing us for the next global epidemic
Quote:
LAST SPRING, AS it does every year, the World Health Organization released a list of infectious diseases that its experts think are especially high-risk—ones that could blow up into epidemics and for which there are no treatments or vaccines.
The list has been created every year since 2014, when the Ebola epidemic in West Africa took the world by surprise. This year’s specimen included the pathogens that public health people consider the usual deadly suspects: Ebola and other hemorrhagic fevers, MERS and SARS, and mosquito-borne Zika and Rift Valley Fever. But there was also a novel entry: Disease X.
Quote:
“Disease X” doesn’t actually exist. The WHO wasn’t warning against a specific pathogen; it was reminding public health and medicine how important it is to be ready for any new illness—especially since existing tests and might not be precise enough to detect a new disease that has epidemic potential, and treatments may not be potent enough to stop it.
In the four years that the list has been published, no emerging infection has been serious enough to rise to the level of Disease X: a pathogen that could sweep the world before science catches up. But a new syndrome, acute flaccid myelitis, or AFM, is providing the first proof of the need for that warning. As perplexing to diagnose as it is to treat, AFM is demonstrating how difficult it can be to understand and predict any new disease. And the challenge of tracking an uncommon illness is giving us a glimpse of how our surveillance systems will struggle to counter the world-spanning epidemic that Disease X may turn out to be.
https://www.wired.com/story/new-dise...obal-epidemic/